1/ #UncleBob has tips for newly minted clinician-educators. Today I will focus on teaching how to take and present the history. #MedEd
@uabimres @UABGIM @SocietyGIM @ACPinternists
2/ Learn to define and expand patient words - e.g., diarrhea (how often, what color, interfere with sleep, etc.). Patients describe things in words they understand, but often we interpret those words differently. Many such examples: chest pain, dyspnea, weakness, SOB, PND
3/ Try to understand the chronology and use that during presentation. This requires careful questioning so that the learner really understands the chronology.
4/ During the presentation consider 2 paragraphs. The first is the story, told chronologically. The second paragraph of the HPI is the relevant ROS, FH, Social History, Behavioral History, medications and past history.
5/ This (IMHO) is the most important trick I have learned. Let the learners know that you will stop the presentation after the HPI and give feedback. Of course, I do not believe you should do this in the pt room.
6/ Feedback includes how the story is told, and what the learner did not tell us. Almost all learners will do a much better job the next time after receiving that feedback. And most learners appreciate immediate feedback.

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More from @medrants

11 Oct
1/ #UncleBob has many thoughts about this tragic tale of diagnostic errors!
@UAB_ID @uabimres @acp @sgim @BradSpellberg @PaulSaxMD @AnaerobeSociety
Hard to Swallow | NEJM nejm.org/doi/full/10.10…
2/ In the very first aliquot we learn that we have a college student with throat pain and chills. We do not know if they were simple chills or rigors. This is actually a BIG DEAL. Rigors (shaking chills) have a high odds ratio for bacteremia.
3/ If she really had rigors, then she needed blood cultures and admission for likely bacteremia. Interesting that she had unilateral tonsillar swelling. I have only seen this once in a patient with Fusobacterium tonsillitis with bacteremia! No data, just an observation
Read 12 tweets
7 Oct
1/ #UncleBob started medical school 50 years ago. Medicine is always progressing. Here are some things we did not have:

Diseases: HIV, Lyme, Takasabu, MRSA

infectious disease Medications: Only 1st generation cephalosporins, no fluoroquinolones, a variety of MRSA drugs, etc.
2/Treatment for HFrEF - first study of decreasing mortality in the 80s, no ACE-I, ARB, beta-blockers, neprolysin inhibitors, Calcium channel blockers

No interventional cardiology - CABG or nothing

M-mode Echo was in its infancy - no 2D echo

No nuclear medicine stress testing
3/ No home oxygen, no home IV infusions

No CT scanning, very little ultrasound (clearly in its infancy), no MRI, no PET

Limited endoscopy and colonoscopy

No "scopic" surgeries - think laparoscopic, arthroscopic, etc

I cannot even describe cancer chemotherapy
Read 6 tweets
27 Sep
1/ #UncleBob is working to better understand hepcidin. Please critique this so that we can have a better understanding.

Hepcidin is a peptide hormone. Its main function is the regulator of iron entry into the circulation
2/ As hepcidin levels increase, iron transport into the circulation decreases. It does this by binding to ferroportin - the transport channel.

Thus - decreased dietary iron absorption. It also leads to iron sequestration in macrophages.
3/ Why should we care? IL-6 (a proinflammatory cytokine) stimulates hepcidin. Thus the anemia of chronic inflammation results from increased hepcidin which in turn makes iron less available to the bone marrow.
Read 6 tweets
31 May
#UncleBob - eGFR Tweetorial

eGFR - estimated GFR
mGFR - measured GFR

@UnremarkableLab
1/ So what is GFR? Glomerular Filtration Rate - how much blood do the kidneys filter per minute

Perfect mGFR -> stable measurable molecule that is perfectly filtered and neither reabsorbed nor secreted
2/ mGFR continued

Measure the plasma value of the molecule and measure the quantity in urine over a specific number of minutes.

Clearance formula - (Um*V/time)/Pm

Since Um is cc and V/time (# of minutes)
The result is cc/ min.
Read 21 tweets
28 Feb
1/ #UncleBob asks you to consider the implications of the famous Nietzsche quote, “There are no facts, only interpretations” These tweets inspired by following @VPrasadMDMPH
We all interpret data differently weighing the risks & benefits.
2/ How else can one explain competing guidelines? Committees look at the same data and make different recommendations. This is the potential flaw in "evidence based medicine".
Confirmation bias influences all these decisions.
3/ The critical care community developed a very aggressive guideline for early treatment of possible sepsis. The ID community left the joint committee and wrote a strong editorial about the risk of over use of antibiotics secondary to this guideline.
Read 6 tweets
27 Feb
#UncleBob is a huge @UVA basketball fan and very proud of our coach Tony Bennett. He took these 5 pillars of our program from his dad (also a great basketball coach. These are very applicable to #MedEd# . ,.,. .
#UncleBob is a huge @uva basketball fan. Our coach, Tony Bennett learned this 5 pillars from his dad (also a great coach). I believe they will resonate with great educators
@UABGIM @CPSolvers @gradydoctor @DxRxEdu @rabihmgeha @andrewolsonmd @LisaWillett13 #MedEd
1/ HUMILITY: KNOW WHO WE ARE
Never overestimate our abilities, but do not underestimate them either. Humility is not modesty, rather it involves knowing who you are and never pretending to be more. Avoid narcissism.
Read 8 tweets

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